Provider Demographics
NPI:1346475290
Name:WILSON, JANELL HILL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JANELL
Middle Name:HILL
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:JANELL
Other - Middle Name:GLENNETTE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:1470 URANIA ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-5239
Mailing Address - Country:US
Mailing Address - Phone:504-881-1452
Mailing Address - Fax:
Practice Address - Street 1:1470 URANIA ST UNIT B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-5239
Practice Address - Country:US
Practice Address - Phone:504-881-1452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2022-09-14
Deactivation Date:2022-08-16
Deactivation Code:
Reactivation Date:2022-09-12
Provider Licenses
StateLicense IDTaxonomies
TXP1185207Q00000X
LA332636207Q00000X
MO2021030371207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129982807Medicaid